Axel Brandes

Aims: The overall aim of this study was to examine the feasibility of a personalized online psychological intervention targeting prevention of depression in patients with atrial fibrillation. Specific objectives were to assess acceptability and adherence to the intervention and explore limited efficacy on patient-reported outcomes. Methods and results: We used a mixed-methods design containing descriptive statistics and ten semi-structured interviews. Participants consisted of 13 women and 15 men and had a mean age of 62 years (range: 26–86). Regarding acceptability, the primary outcome was drop-out, and we found a drop-out rate of 7% among the participating patients (2/28). Completed patients were fully adherent to their personalized planned intervention. For patient-reported outcomes, all mean measures on mental health and health-related quality of life were improved post-intervention. This included depression as measured with the Hospital Anxiety and Depression Scale. From thematic analysis on the interviews, we generated four themes consisting of meaningful content, communication, technicalities, and personal gain. Overall, patients perceived their personalized intervention relevant for their individual situation, they felt engaged in planning of their intervention and that online treatment allowed a high level of autonomy. Patients felt empowered and experienced that the acquired psychological tools were useful in everyday life with atrial fibrillation. Conclusion: This feasibility study demonstrated a low drop-out rate and high adherence to the intervention. Completion of intervention was associated with potentially improved mental health. The findings support a future randomized controlled trial to evaluate clinical and cost effectiveness of the intervention. Registration: ClinicalTrials.gov: NCT07178691

Aims: Inflammation is central in atrial fibrillation (AF) pathophysiology, but the temporal association between inflammatory activity and AF remains uncertain. This study investigated the day-to-day relationship between plasma C-reactive protein (CRP) levels and AF occurrence in continuously monitored individuals. Methods and results: Post hoc analysis of the LOOP study randomizing participants with stroke risk factors to implantable loop recorder (ILR) screening (n = 1501) or usual care. ILR raw data were linked to blood samples collected within 1 day. The outcome was AF episodes lasting ≥60 min. Associations were examined using generalized and linear mixed models and as a self-controlled case series (SCCS). ILR and CRP data were available for 1065 participants combining >1.2 million days of heart rhythm monitoring (including ∼40 000 days with AF) with >7000 CRP measurements. CRP was higher during days with AF (geometric mean 8.37 [7.11–9.86] mg/L) vs. non-AF days (4.02 [3.71–4.35] mg/L). Each doubling of CRP was associated with 36% higher odds of AF (adjusted odds ratio [aOR] 1.36 [1.26–1.47]). Compared with CRP ≤3 mg/L, the odds of AF increased for CRP >10–50 and >50 mg/L (aOR 3.50 [2.18–5.60] and 5.75 [3.48–9.50], respectively). In SCCS analyses, CRP >10 mg/L was associated with higher incidence of AF compared to lower levels (incidence rate ratio 2.41 [1.53–3.80]). Conclusion: This exploratory study found a temporal and dose–response relationship between CRP levels and AF occurrence, supporting inflammation as an acute trigger and underscoring the need to evaluate inflammatory markers as potential targets in AF management. Trial Registration: ClinicalTrials.gov, identifier: NCT02036450.

Background: Subclinical atrial fibrillation (SCAF) poses an increased stroke risk, but whether oral anticoagulation for SCAF prevents stroke is unclear. We sought to investigate the treatment effect of SCAF screening according to measures of cardiac structure and function. Methods: This was an echocardiographic substudy of the LOOP (Atrial Fibrillation Detected by Continuous ECG Monitoring) study, which randomized older people at risk of stroke to usual care or an implantable loop recorder (ILR) with monitoring for SCAF and subsequent oral anticoagulation. A subset (24% of trial population) underwent echocardiography to measure left ventricular size and function, left atrial volume and strain, and valvular pathology. The primary outcome was a composite of stroke or systemic embolism. Results: The study included 1422 participants (ILR: n=1001; control: n=421; mean age: 74 years; men: 54%). During follow‐up, 354 (25%) were diagnosed with AF (ILR versus control: 30% versus 12%). During a median follow‐up of 5.5 years (interquartile range, 4.9–5.9 years), 55 (4%) developed the primary outcome (ILR versus control: 3.9% versus 3.8%). No conventional measure of cardiac structure and function modified the treatment effect from randomization. However, left atrial contraction strain significantly modified the treatment effect ( P interaction=0.003), such that a lower risk of the primary outcome was noted from ILR with lower left atrial contraction strain values (hazard ratio [HR], 0.38 [95% CI, 0.16–0.87], for participants with contraction strain<16.5%). Conclusion: In a post hoc analysis of the LOOP study, conventional echocardiographic measures did not modify the effect of SCAF screening for stroke prevention. However, a significant stroke risk reduction was observed from ILR randomization among participants with reduced left atrial contraction strain.

Aims: This study aimed to establish general consensus on a systematic needs assessment model to determine eligibility for cardiac rehabilitation (CR) as part of secondary prevention in individuals with atrial fibrillation (AF). Specific objectives included identifying relevant needs assessment criteria and establishing consensus on referral criteria. Methods and results: A Delphi study was conducted following the ACCORD guidelines (ACcurate COnsensus Reporting Document) with participation of an international, multi-disciplinary expert panel including physicians, nurses, and other healthcare professionals, across primary and secondary care as well as academic research. The panel also included six people who had AF themselves. The Delphi process involved three iterative rounds of surveys and a video meeting to determine needs assessment criteria and facilitate consensus. Data collection included qualitative feedback and quantitative voting on proposed criteria. Sixty-nine experts participated. There was high agreement on the importance of the study, which identified 12 needs assessment criteria related to AF symptom burden, health-related quality of life, anxiety, medicine adherence, and various risk factors. Whilst there was agreement on the needs assessment model, experts noted that referral criteria should be flexible and tailored to local healthcare settings, emphasizing that each individual's situation is unique. Conclusion: This Delphi study established a needs assessment model that can be adapted to local contexts for individuals with AF. More research is needed to refine referral criteria and ensure effective implementation of individually tailored CR strategies.